1
|
Fleury Curado T, El Abany A, Most SP. Sliding Spine Relocation Surgery with Anterior Septal Reconstruction. Craniomaxillofac Trauma Reconstr 2024; 17:56-60. [PMID: 38371217 PMCID: PMC10874202 DOI: 10.1177/19433875231152947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Study Design: Technical note. Objective: The lower nasal architecture is dependent on caudal septal integrity. Deviations of the caudal septum can compromise nasal airflow. The presence of anterior nasal spine deviations contributes to septal and medial crural shifting with ipsilateral encroachment. It is essential to identify nasal spine deviation during surgery in order to reconstruct the septum in a midline position at its base. This allows an appropriate management plan that creates a better functional and aesthetically pleasing outcome. A stable midline anterior nasal spine is warranted to support the newly reconstructed straight caudal strut, which can be effectively corrected by anterior septal reconstruction. Methods: The proposed method intends to combine anterior nasal spine centralization with correcting caudal septal deviation and nasal obstruction through a modified extracorporeal septoplasty technique. We describe a novel technique to centralize the deviated anterior nasal spine using the piezoelectric device by performing a contralateral adjacent ostectomy and en-bloc relocation and fixation of the anterior nasal spine with microplates and screws. Results: This surgical approach creates a stable caudal septum and a centrally positioned anterior nasal spine, which improves nasal airflow and ensures a stable repair. Conclusion: Sliding spine relocation surgery with anterior septal reconstruction repositions a deviated anterior nasal spine and corrects caudal septum deviation, that can impair the nasal airway.
Collapse
Affiliation(s)
- Thomaz Fleury Curado
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ahmed El Abany
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Maxillofacial & Plastic Surgery, Alexandria University, Faculty of Dentistry, Alexandria, Egypt
| | - Sam P. Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
2
|
Fleury Curado T, Pham L, Otvos T, Klopfer T, Freire C, Amorim MR, Nishimura Y, Sennes LU, Psoter KJ, Abdelwahab M, Huang A, Dedhia R, Liu S, Capasso R, Oliven A, Polotsky V, Eisele D, Schwartz A. Changes in tongue morphology predict responses in pharyngeal patency to selective hypoglossal nerve stimulation. J Clin Sleep Med 2023; 19:947-955. [PMID: 36727502 PMCID: PMC10152343 DOI: 10.5664/jcsm.10474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES The major goal of the study was to determine whether changes in tongue morphology under selective hypoglossal nerve therapy for obstructive sleep apnea were associated with alterations in airway patency during sleep when specific portions of the hypoglossal nerve were stimulated. METHODS This case series was conducted at the Johns Hopkins Sleep Disorders Center at Johns Hopkins Bayview Medical Center. Twelve patients with apnea implanted with a multichannel targeted hypoglossal nerve-stimulating system underwent midsagittal ultrasound tongue imaging during wakefulness. Changes in tongue shape were characterized by measuring the vertical height and polar dimensions between tongue surface and genioglossi origin in the mandible. Changes in patency were characterized by comparing airflow responses between stimulated and adjacent unstimulated breaths during non-rapid eye movement sleep. RESULTS Two distinct morphologic responses were observed. Anterior tongue base and hyoid-bone movement (5.4 [0.4] to 4.1 [1.0] cm (median and [interquartile range]) with concomitant increases in tongue height (5.0 [0.9] to 5.6 [0.7] cm) were associated with decreases in airflow during stimulation. In contrast, comparable anterior hyoid movement (tongue protrusion from 5.8 [0.5] to 4.5 [0.9] cm) without significant increases in height (5.2 [1.6] to 4.6 [0.8] cm) were associated with marked increases in airflow during sleep. CONCLUSIONS Tongue protrusion with preservation of tongue shape predicted increases in patency, whereas anterior movement with concomitant increases in height were associated with decreased pharyngeal patency. These findings suggest that pharyngeal patency can be best stabilized by stimulating lingual muscles that maintain tongue shape while protruding the tongue, thereby preventing it from prolapsing posteriorly during sleep. CITATION Fleury Curado T, Pham L, Otvos T, et al. Changes in tongue morphology predict responses in pharyngeal patency to selective hypoglossal nerve stimulation. J Clin Sleep Med. 2023;19(5):947-955.
Collapse
Affiliation(s)
- Thomaz Fleury Curado
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Luu Pham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tamas Otvos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tracy Klopfer
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carla Freire
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Mateus R. Amorim
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yoichi Nishimura
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luiz Ubirajara Sennes
- Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kevin J. Psoter
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamed Abdelwahab
- Sleep Surgery Division, Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Allen Huang
- Sleep Surgery Division, Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Raj Dedhia
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- B’nai Zion Hospital, Technion School of Medicine, Haifa, Israel
| | - Stanley Liu
- Sleep Surgery Division, Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Robson Capasso
- Sleep Surgery Division, Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Arie Oliven
- Department of Otorhinolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Vsevolod Polotsky
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Eisele
- Department of Otorhinolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alan Schwartz
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Hsieh YH, Schell AE, Yeh E, Strohl MP, Curado TF, Strohl KP. Neurostimulation in the Management of Obstructive Sleep Apnea. Curr Sleep Medicine Rep 2022. [DOI: 10.1007/s40675-022-00233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
4
|
Fleury Curado T, Pho H, Freire C, Amorim MR, Bonaventura J, Kim LJ, Lee R, Cabassa ME, Streeter SR, Branco LG, Sennes LU, Fishbein K, Spencer RG, Schwartz AR, Brennick MJ, Michaelides M, Fuller DD, Polotsky VY. Designer Receptors Exclusively Activated by Designer Drugs Approach to Treatment of Sleep-disordered Breathing. Am J Respir Crit Care Med 2021; 203:102-110. [PMID: 32673075 DOI: 10.1164/rccm.202002-0321oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Obstructive sleep apnea is recurrent upper airway obstruction caused by a loss of upper airway muscle tone during sleep. The main goal of our study was to determine if designer receptors exclusively activated by designer drugs (DREADD) could be used to activate the genioglossus muscle as a potential novel treatment strategy for sleep apnea. We have previously shown that the prototypical DREADD ligand clozapine-N-oxide increased pharyngeal diameter in mice expressing DREADD in the hypoglossal nucleus. However, the need for direct brainstem viral injections and clozapine-N-oxide toxicity diminished translational potential of this approach, and breathing during sleep was not examined.Objectives: Here, we took advantage of our model of sleep-disordered breathing in diet-induced obese mice, retrograde properties of the adeno-associated virus serotype 9 (AAV9) viral vector, and the novel DREADD ligand J60.Methods: We administered AAV9-hSyn-hM3(Gq)-mCherry or control AAV9 into the genioglossus muscle of diet-induced obese mice and examined the effect of J60 on genioglossus activity, pharyngeal patency, and breathing during sleep.Measurements and Main Results: Compared with control, J60 increased genioglossus tonic activity by greater than sixfold and tongue uptake of 2-deoxy-2-[18F]fluoro-d-glucose by 1.5-fold. J60 increased pharyngeal patency and relieved upper airway obstruction during non-REM sleep.Conclusions: We conclude that following intralingual administration of AAV9-DREADD, J60 can activate the genioglossus muscle and improve pharyngeal patency and breathing during sleep.
Collapse
Affiliation(s)
- Thomaz Fleury Curado
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Otolaryngology, University of São Paulo, São Paulo, Brazil
| | - Huy Pho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carla Freire
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Otolaryngology, University of São Paulo, São Paulo, Brazil
| | - Mateus R Amorim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Dental School of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Jordi Bonaventura
- Biobehavioral Imaging and Molecular Neuropsychopharmacology Unit, National Institute on Drug Abuse, and
| | - Lenise J Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, Maryland
| | - Rachel Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meaghan E Cabassa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stone R Streeter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luiz G Branco
- Dental School of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Luiz U Sennes
- Department of Otolaryngology, University of São Paulo, São Paulo, Brazil
| | - Kenneth Fishbein
- Departament of Psychobiology, Federal University of São Paulo, São Paulo, Brazil
| | - Richard G Spencer
- Departament of Psychobiology, Federal University of São Paulo, São Paulo, Brazil
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Michael J Brennick
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Michaelides
- Biobehavioral Imaging and Molecular Neuropsychopharmacology Unit, National Institute on Drug Abuse, and
| | - David D Fuller
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
5
|
Curado TF, Pho H, Lee R, Kim L, Brennick M, Fishbein K, Bonaventura J, Michaelides M, Dergacheva O, Mendelowitz D, Schwartz A, Polotsky V. Targeted Retrograde Chemogenetic Approach to Treat Sleep Apnea. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.06437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
6
|
Kim LJ, Freire C, Fleury Curado T, Jun JC, Polotsky VY. The Role of Animal Models in Developing Pharmacotherapy for Obstructive Sleep Apnea. J Clin Med 2019; 8:jcm8122049. [PMID: 31766589 PMCID: PMC6947279 DOI: 10.3390/jcm8122049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent closure of the upper airway during sleep. It has a complex pathophysiology involving four main phenotypes. An abnormal upper airway anatomy is the key factor that predisposes to sleep-related collapse of the pharynx, but it may not be sufficient for OSA development. Non-anatomical traits, including (1) a compromised neuromuscular response of the upper airway to obstruction, (2) an unstable respiratory control (high loop gain), and (3) a low arousal threshold, predict the development of OSA in association with anatomical abnormalities. Current therapies for OSA, such as continuous positive airway pressure (CPAP) and oral appliances, have poor adherence or variable efficacy among patients. The search for novel therapeutic approaches for OSA, including pharmacological agents, has been pursued over the past years. New insights into OSA pharmacotherapy have been provided by preclinical studies, which highlight the importance of appropriate use of animal models of OSA, their applicability, and limitations. In the present review, we discuss potential pharmacological targets for OSA discovered using animal models.
Collapse
|
7
|
Affiliation(s)
| | - Slava Berger
- 1 Johns Hopkins University School of Medicine Baltimore, Maryland
| | | |
Collapse
|
8
|
Fleury Curado T, Pho H, Berger S, Caballero-Eraso C, Shin MK, Sennes LU, Pham L, Schwartz AR, Polotsky VY. Sleep-disordered breathing in C57BL/6J mice with diet-induced obesity. Sleep 2019; 41:4996050. [PMID: 29767787 DOI: 10.1093/sleep/zsy089] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 01/19/2023] Open
Abstract
Obesity leads to sleep-disordered breathing (SDB) manifested by recurrent upper airway obstructions termed obstructive sleep apnea (OSA) and carbon dioxide retention due to hypoventilation. The objective of this work was to characterize breathing during sleep in C57BL6/J mice with diet-induced obesity (DIO). Arterial blood gas was measured in nine obese and nine lean mice during wakefulness. Nine male mice with DIO and six lean male C57BL/6J mice were head mounted with electroencephalogram (EEG) and electromyogram (EMG) electrodes. Sleep recordings were performed in the whole body plethysmography chamber; upper airway obstruction was characterized by the presence of inspiratory flow limitation in which airflow plateaus with increases in inspiratory effort. Obese mice showed significantly lower pH and higher partial pressure of arterial CO2 (PaCO2) in arterial blood gas compared to lean mice, 7.35 ± 0.04 versus 7.46 ± 0.06 (p < 0.001) and 38 ± 8 mm Hg versus 30 ± 5 mm Hg (p < 0.001). Obese mice had similar levels of minute ventilation to lean mice during sleep and wakefulness, despite higher body weight and temperature, indicating an increase in the metabolic rate and hypoventilation. Obese mice also showed baseline hypoxemia with decreased mean oxyhemoglobin saturation across sleep/wake states. Obese mice had a higher prevalence of flow-limited breathing compared to lean mice during sleep. However, the oxygen desaturation index in lean and obese mice did not differ. We conclude that DIO in mice leads to hypoventilation. Obesity also increases the frequency of inspiratory limited breaths, but it does not translate into progression of OSA.
Collapse
Affiliation(s)
- Thomaz Fleury Curado
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Otolaryngology, University of Sao Paulo, Sao Paulo, Brazil
| | - Huy Pho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | - Slava Berger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | - Candela Caballero-Eraso
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
| | - Mi-Kyung Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Luu Pham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
9
|
Nishimura Y, Arias RS, Pho H, Pham LV, Curado TF, Polotsky VY, Schwartz AR. 0126 A Novel Non-invasive Approach for Measuring Upper Airway Collapsibility in Mice. Sleep 2019. [DOI: 10.1093/sleep/zsz067.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yoichi Nishimura
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Teikyo University Chiba Medical Center, Chiba, Japan
| | - Rafael S Arias
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Huy Pho
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
10
|
Pho H, Berger S, Freire C, Dergacheva O, Curado TF, Schwartz AR, Mendelowitz D, Polotsky VY. 0002 Leptin Receptor Positive Neurons In The Dorsomedial Hypothalamus Maintain Upper Airway Patency During Sleep. Sleep 2019. [DOI: 10.1093/sleep/zsz067.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Huy Pho
- Johns Hopkins, Baltimore, MD, USA
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Nishimura Y, Arias RS, Pho H, Pham LV, Curado TF, Polotsky VY, Schwartz AR. A Novel Non-invasive Approach for Measuring Upper Airway Collapsibility in Mice. Front Neurol 2018; 9:985. [PMID: 30524362 PMCID: PMC6256100 DOI: 10.3389/fneur.2018.00985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/31/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction: Invasive procedures were previously developed for measuring pharyngeal collapsibility in rodents during expiration, when declining neuromuscular activity makes the airway unstable. We developed a non-invasive approach for streamlining collapsibility measurements by characterizing responses in physiologic markers of dynamic expiratory airflow obstruction to negative nasal pressure challenges. Methods: Anesthetized mice were instrumented to monitor upper airway pressure-flow relationships with head-out plethysmography while nasal pressure was ramped down from ~ +5 to -20 cm H2O over several breaths. Inspiratory and expiratory flow, volume, and timing characteristics were assessed breath-wise. Pcrit was estimated at transitions in expiratory amplitude and timing parameters, and compared to gold standard PCRIT measurements when nasal and tracheal pressures diverged during expiration. Predictions equations were constructed in a development data set (n = 8) and applied prospectively to a validation data set (n = 16) to estimate gold standard PCRIT. Results: The development data demonstrated that abrupt reversals in expiratory duration and tidal volume during nasal pressure ramps predicted gold standard PCRIT measurements. After applying regression equations from the development to a validation dataset, we found that a combination of expiratory amplitude and timing parameters proved to be robust predictors of gold standard PCRIT with minimal bias and narrow confidence intervals. Conclusions: Markers of expiratory airflow obstruction can be used to model upper airway collapsibility, and can provide sensitive measures of changes in airway collapsibility in rodents. This approach streamlines repeated non-invasive PCRIT measurements, and facilitates studies examining the impact of genetic, environmental, and pharmacologic factors on upper airway control.
Collapse
Affiliation(s)
- Yoichi Nishimura
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Department of Otolaryngology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Rafael S Arias
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Huy Pho
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Luu Van Pham
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Thomaz Fleury Curado
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
12
|
Fleury Curado T, Oliven A, Sennes LU, Polotsky VY, Eisele D, Schwartz AR. Neurostimulation Treatment of OSA. Chest 2018; 154:1435-1447. [PMID: 30222959 DOI: 10.1016/j.chest.2018.08.1070] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 01/04/2023] Open
Abstract
Over the past 30 years, hypoglossal nerve stimulation has moved through a development pathway to become a viable treatment modality for patients with OSA. Initial pilot studies in animals and humans laid the conceptual foundation for this approach, leading to the development of fully implantable stimulating systems for therapeutic purposes. These devices were then shown to be both safe and efficacious in feasibility studies. One such closed-loop stimulating device was found to be effective in treating a limited spectrum of apneic patients and is currently approved by the US Food and Drug Administration for this purpose. Another open-loop stimulating system is currently being rigorously tested in a pivotal trial. Collectively, clinical trials of hypoglossal nerve stimulating systems have yielded important insights that can help optimize therapeutic responses to hypoglossal nerve stimulation. These insights include specific patient selection criteria and methods for delivering stimulation to specific portions of the hypoglossal nerve and/or genioglossus muscle. New approaches for activating efferent and afferent motor pathways are currently in early-stage laboratory development and hold some long-term promise as a novel therapy.
Collapse
Affiliation(s)
- Thomaz Fleury Curado
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil.
| | - Arie Oliven
- Department of Medicine, Bnai Zion Medical Center, Technion, Haifa, Israel
| | - Luiz U Sennes
- Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Eisele
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
13
|
Nishimura Y, Arias RS, Curado TF, Pho H, Polotsky VY, Suzuki M, Schwartz AR. 0135 Signs of Expiratory Airflow Obstruction In Mouse Model Of Pharyngeal Collapsibility. Sleep 2018. [DOI: 10.1093/sleep/zsy061.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Nishimura
- Johns Hopkins Sleep Disorders Center, Baltimore, MD
- Teikyo University Chiba Medical Center, Chiba, JAPAN
| | - R S Arias
- Johns Hopkins Sleep Disorders Center, Baltimore, MD
| | - T F Curado
- Johns Hopkins Sleep Disorders Center, Baltimore, MD
| | - H Pho
- Johns Hopkins Sleep Disorders Center, Baltimore, MD
| | - V Y Polotsky
- Johns Hopkins Sleep Disorders Center, Baltimore, MD
| | - M Suzuki
- Teikyo University Chiba Medical Center, Chiba, JAPAN
| | - A R Schwartz
- Johns Hopkins Sleep Disorders Center, Baltimore, MD
| |
Collapse
|
14
|
Fleury Curado T, Fishbein K, Pho H, Brennick M, Dergacheva O, Sennes LU, Pham LV, Ladenheim EE, Spencer R, Mendelowitz D, Schwartz AR, Polotsky VY. Chemogenetic stimulation of the hypoglossal neurons improves upper airway patency. Sci Rep 2017; 7:44392. [PMID: 28281681 PMCID: PMC5345079 DOI: 10.1038/srep44392] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/07/2017] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction during sleep. OSA leads to high cardiovascular morbidity and mortality. The pathogenesis of OSA has been linked to a defect in neuromuscular control of the pharynx. There is no effective pharmacotherapy for OSA. The objective of this study was to determine whether upper airway patency can be improved using chemogenetic approach by deploying designer receptors exclusively activated by designer drug (DREADD) in the hypoglossal motorneurons. DREADD (rAAV5-hSyn-hM3(Gq)-mCherry) and control virus (rAAV5-hSyn-EGFP) were stereotactically administered to the hypoglossal nucleus of C57BL/6J mice. In 6-8 weeks genioglossus EMG and dynamic MRI of the upper airway were performed before and after administration of the DREADD ligand clozapine-N-oxide (CNO) or vehicle (saline). In DREADD-treated mice, CNO activated the genioglossus muscle and markedly dilated the pharynx, whereas saline had no effect. Control virus treated mice showed no effect of CNO. Our results suggest that chemogenetic approach can be considered as a treatment option for OSA and other motorneuron disorders.
Collapse
Affiliation(s)
- Thomaz Fleury Curado
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The John Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology, the University of São Paulo, São Paulo, Brazil
| | - Kenneth Fishbein
- National Institutes of Health, National Institute of Aging, Baltimore, MD, USA
| | - Huy Pho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Brennick
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olga Dergacheva
- Department of Pharmacology and Physiology, The George Washington University, Washington, DC USA
| | - Luiz U Sennes
- Department of Otolaryngology, the University of São Paulo, São Paulo, Brazil
| | - Luu V Pham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen E Ladenheim
- Department of Psychiatry, The John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Spencer
- National Institutes of Health, National Institute of Aging, Baltimore, MD, USA
| | - David Mendelowitz
- Department of Pharmacology and Physiology, The George Washington University, Washington, DC USA
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The John Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|